registration Home > Register registration form All fields are mandatory personal particulars Price: S$1,080 for 1 Year Name (as per NRIC):* Name (as per NRIC) is Required ALPA-S MEMBERSHIP NO:* ALPA-S MEMBERSHIP NO is Required IC/UIN/FIN Number:* IC/UIN/FIN Number is Required Date of Birth:* Date of Birth is Required Age Last Birthday:* Age Last Birthday is Required Gender:* Gender is Required MaleFemale Race:* Race is Required Date of Successful Medical Renewal (if within 3 months of application date):* Date of Successful Medical Renewal (if within 3 months of application date) is Required License Expiry Date:* License Expiry Date is Required Residential Status:* Residential Status is Required SingaporeanSingaporean PROthers Residential Status | Others (Please specify): Residential Status | Others (Please specify) is not valid Nationality:* Nationality is Required Rank:* Rank is Required CAPTFOJFOSO Address:* Address is Required Unit No.:* Unit No. is Required Postal:* Postal is Required Home Tel:* Home Tel is Required Mobile:* Mobile is Required Email (non-company):* Email (non-company) is Required Nominee's Name (as per NRIC):* Nominee's Name (as per NRIC) is Required Relationship:* Relationship is Required WifeHusbandFatherMotherSonDaughterBrotherSisterGrandparentGrandchildSon-in-lawDaughter-in-lawUncleAuntNieceNephewSpouse IC/UIN/FIN Number:* IC/UIN/FIN Number is Required Address (if different from above):* Address (if different from above) is Required Home Tel:* Home Tel is Required Mobile:* Mobile is Required Email:* Email is Required LICENSE NO:* LICENSE NO is Required COMPANY:* COMPANY is Required SIASCOOT STAFF NUMBER:* STAFF NUMBER is Required Date of Employment (for DECA/DEFO) *to be supported with employment letter only:* Date of Employment (for DECA/DEFO) *to be supported with employment letter only is Required Checkout Date (ab initio) *to be supported with appointment letter only:* Checkout Date (ab initio) *to be supported with appointment letter only is Required FLEET:* FLEET is Required State Overseas Flying License Type, Number and Validity. IF ANY:* State Overseas Flying License Type, Number and Validity. IF ANY is Required I have / have not* previously claimed for Loss of License. :* I have / have not* previously claimed for Loss of License. is Required I have notI have STATE THE CONDITIONS:* STATE THE CONDITIONS is Required I have / do not have* an exclusion endorsed from LOL Insurance. :* I have / do not have* an exclusion endorsed from LOL Insurance. is Required I do not haveI have STATE THE CONDITIONS:* STATE THE CONDITIONS is Required Employment Letter:* Employment Letter is Required Letter of Appointment:* Letter of Appointment is Required Flying License Pg1-8, M1, M2, C1 and C2:* Flying License Pg1-8, M1, M2, C1 and C2 is Required Other Specified Medical Reports as stated on your License: Other Specified Medical Reports as stated on your License is not valid Overseas License: Overseas License is not valid I consent to the MBO sharing my personal data with ALPA-S and other third parties as stipulated in the MBO PDPA Policy.* I declare that all information given is true and accurate.* I agree to pay my yearly subscription through PayNow.* I shall give 30 days notice in writing of any event that might reasonably give rise to a claim against the MBO. Joining Deposit ($1080 for Capt/FO/JFO and $360 for SO) must accompany this application.* Have you ever been grounded or had a license invalidated for medical reasons? Have you ever been grounded or had a license invalidated for medical reasons?:* Have you ever been grounded or had a license invalidated for medical reasons? is Required Yes No Has any limitation ever been endorsed on any of your licenses? Has any limitation ever been endorsed on any of your licenses?:* Has any limitation ever been endorsed on any of your licenses? is Required Yes No Has any Insurance Company or Underwriter declined or deferred a proposal from you? Has any Insurance Company or Underwriter declined or deferred a proposal from you?:* Has any Insurance Company or Underwriter declined or deferred a proposal from you? is Required Yes No Has any Insurance Company or Underwriter charged or quoted more than standard rates? Has any Insurance Company or Underwriter charged or quoted more than standard rates?:* Has any Insurance Company or Underwriter charged or quoted more than standard rates? is Required Yes No Has any Insurance Company or Underwriter imposed an exclusion or waiver on your insurance cover? Has any Insurance Company or Underwriter imposed an exclusion or waiver on your insurance cover?:* Has any Insurance Company or Underwriter imposed an exclusion or waiver on your insurance cover? is Required Yes No Has any Insurance Company or Underwriter cancelled or declined to renew your insurance? Has any Insurance Company or Underwriter cancelled or declined to renew your insurance?:* Has any Insurance Company or Underwriter cancelled or declined to renew your insurance? is Required Yes No Have you ever been declined any medical or life insurance cover? If you have answered “yes” to any of the above, please give full details in section 6 Have you ever been declined any medical or life insurance cover? If you have answered “yes” to any of the above, please give full details in section 6:* Have you ever been declined any medical or life insurance cover? If you have answered “yes” to any of the above, please give full details in section 6 is Required Yes No Have you ever suffered from any conditions or illnesses which necessitated hospital attendance, admission, diagnosis or treatment? Have you ever suffered from any conditions or illnesses which necessitated hospital attendance, admission, diagnosis or treatment?:* Have you ever suffered from any conditions or illnesses which necessitated hospital attendance, admission, diagnosis or treatment? is Required Yes No After or during a medical examination have you ever: been required to take additional tests? After or during a medical examination have you ever: been required to take additional tests? :* After or during a medical examination have you ever: been required to take additional tests? is Required Yes No After or during a medical examination have you ever: been referred for specialist examination? After or during a medical examination have you ever: been referred for specialist examination?:* After or during a medical examination have you ever: been referred for specialist examination? is Required Yes No After or during a medical examination have you ever: had the issue or renewal of your medical certificate deferred? After or during a medical examination have you ever: had the issue or renewal of your medical certificate deferred?:* After or during a medical examination have you ever: had the issue or renewal of your medical certificate deferred? is Required Yes No After or during a medical examination have you ever: had to return for examination at less than the normal interval? After or during a medical examination have you ever: had to return for examination at less than the normal interval?:* After or during a medical examination have you ever: had to return for examination at less than the normal interval? is Required Yes No After or during a medical examination have you ever: been ordered to take drugs or follow any special diet? After or during a medical examination have you ever: been ordered to take drugs or follow any special diet?:* After or during a medical examination have you ever: been ordered to take drugs or follow any special diet? is Required Yes No Are you aware of any deterioration in your general health, eyesight or blood pressure? If you have answered “yes” to any of the above, please give full details in section 6 Are you aware of any deterioration in your general health, eyesight or blood pressure? If you have answered “yes” to any of the above, please give full details in section 6 :* Are you aware of any deterioration in your general health, eyesight or blood pressure? If you have answered “yes” to any of the above, please give full details in section 6 is Required Yes No Have you or either of your natural parents been investigated, diagnosed or treated for: any psychiatric or nervous disorder (including migraine), epilepsy or any other form of convulsion or loss of consciousness? Have you or either of your natural parents been investigated, diagnosed or treated for: any psychiatric or nervous disorder (including migraine), epilepsy or any other form of convulsion or loss of consciousness?:* Have you or either of your natural parents been investigated, diagnosed or treated for: any psychiatric or nervous disorder (including migraine), epilepsy or any other form of convulsion or loss of consciousness? is Required Yes No Have you or either of your natural parents been investigated, diagnosed or treated for: any high blood pressure, stroke, circulatory or respiratory disorder? Have you or either of your natural parents been investigated, diagnosed or treated for: any high blood pressure, stroke, circulatory or respiratory disorder?:* Have you or either of your natural parents been investigated, diagnosed or treated for: any high blood pressure, stroke, circulatory or respiratory disorder? is Required Yes No Have you or either of your natural parents been investigated, diagnosed or treated for: any condition involving eyes, ears, nose or throat, alimentary tract or genito-urinary system? Have you or either of your natural parents been investigated, diagnosed or treated for: any condition involving eyes, ears, nose or throat, alimentary tract or genito-urinary system? :* Have you or either of your natural parents been investigated, diagnosed or treated for: any condition involving eyes, ears, nose or throat, alimentary tract or genito-urinary system? is Required Yes No Have you or either of your natural parents been investigated, diagnosed or treated for: any disorder of the blood or lymphatic system? Have you or either of your natural parents been investigated, diagnosed or treated for: any disorder of the blood or lymphatic system?:* Have you or either of your natural parents been investigated, diagnosed or treated for: any disorder of the blood or lymphatic system? is Required Yes No Have you or either of your natural parents been investigated, diagnosed or treated for: any condition affecting bones and/or joints, incl. spinal conditions? Have you or either of your natural parents been investigated, diagnosed or treated for: any condition affecting bones and/or joints, incl. spinal conditions? :* Have you or either of your natural parents been investigated, diagnosed or treated for: any condition affecting bones and/or joints, incl. spinal conditions? is Required Yes No Have you or either of your natural parents been investigated, diagnosed or treated for: any disorder of the skin? Have you or either of your natural parents been investigated, diagnosed or treated for: any disorder of the skin?:* Have you or either of your natural parents been investigated, diagnosed or treated for: any disorder of the skin? is Required Yes No Have you or either of your natural parents been investigated, diagnosed or treated for: diabetes? If “yes ” please give details and results in section 6 Have you or either of your natural parents been investigated, diagnosed or treated for: diabetes? If “yes ” please give details and results in section 6:* Have you or either of your natural parents been investigated, diagnosed or treated for: diabetes? If “yes ” please give details and results in section 6 is Required Yes No Have you ever had an HIV/AIDS test or been personally counselled or medically advised in connection with AIDS or any sexually transmitted disease? Have you ever had an HIV/AIDS test or been personally counselled or medically advised in connection with AIDS or any sexually transmitted disease? :* Have you ever had an HIV/AIDS test or been personally counselled or medically advised in connection with AIDS or any sexually transmitted disease? is Required Yes No If your answer is “Yes” to HIV/AIDS test, please advise the following : Date of test: If your answer is “Yes” to HIV/AIDS test, please advise the following : Date of test is not valid Test result Test result:* Test result is Required HIV Negative HIV Positive Section 6 Additional Information:* Section 6 Additional Information is Required NIL I hereby declare to the best of my knowledge and belief the answers given, whether in my handwriting or not, to the questions contained in the Application are true and complete. I agree that this Application and Declaration shall form the basis of the contract between me and ALPA-S MBO should my Application be approved. I also hereby certify that: * I hold a valid current Singapore Class 1 medical certificate forming part of the Pilot’s License(s) specified in Section 1. * At the date of this Application I am actively working, or am available for work for the aforementioned Employer, in the capacity for which I hold the License(s) specified in Section 1.* At the date of this Application I have not passed my 55th birthday.* At the date of this Application I am within 2 years from my date of appointment to Junior First Officer Grade (A320/A319), First Officer Grade or Second Officer Grade, or within 2 years of my joining date as a Direct Entry Captain or Direct Entry First Officer.* I acknowledge and understand that my membership will become effective on the first day of the month following the approval of my Application, provided that I am actively working or am available for work on that date. I further understand that if I am not actively working or available for work on that date, this membership application shall be void.* I confirm that I understand and agree to the Personal Data Protection Policy of the ALPA-S MBO residing on the website.* Email:* Invalid Email Password:* Invalid Password Password Confirmation:* Password Confirmation Doesn't Match Offline No val Please fix the errors above
